Pulse - Revolutionary Mindset

The
Revolutionary
Mindset and
Redesign of
Health Care
Pulse Event
November 12, 2013
Mike
Slubowski, FACHE, FAC
MPE
President/CEO

© SCL Health System

1

Incumbents vs. Revolutionaries
• Incumbents
– The old model has worked for an extended time period
– In “Maintenance Mode” – don’t want to mess with “the
formula”
– Leverage brand and historical reputation
– Adopting any new approach puts the model at risk
• Can cannibalize one’s own business

– Very few have adopted a revolutionary mindset and have
been successful at changing the model

• Revolutionaries
– Victory comes by changing the model
– Being scrappy, open to invention, leverage out-of-the-box
thinking

2

Outline
•
•
•
•
•

Brief background on SCL Health System
The environment we face
Why is “revolutionary behavior” an imperative?
How are we transforming?
Closing thoughts

4

Brief Background: SCL Health System

5

Where We Serve

Size and scope….1
9

Hospitals

4

Safety net clinics

1

Mental health treatment
center for children

190+

Ambulatory practices

500+

Employed physicians

$2.2
Billion

2012 net patient service
revenue

1Continuing operations

6

Mission, Vision and Values
MISSION
We reveal and foster God’s healing love by improving the health of the people and
communities we serve, especially those who are poor and vulnerable.

VISION
Inspired by our faith,
• We will be distinguished as the premier person-centered health system and trusted partner.
• We will share accountability with clinicians and other stakeholders to coordinate care across
all settings and improve access, quality, health outcomes and affordability.
• We will grow as community-based health networks to serve more people in partnership with
others who share our vision and values.

VALUES
Caring Spirit

We honor the sacred dignity of each person.

Excellence

We set and surpass high standards.

Good Humor

We create joyful and welcoming environments.

Integrity

We do the right thing with openness and pride.

Safety

We deliver care that seeks to eliminate all harm for patients and associates.

Stewardship

We are accountable for the resources entrusted to us.
7


Strategic Priorities & Key Initiatives
Ministry
Excellence

• Community health improvement
• Quality, safety, patient experience
• Financial and operational

Leverage Skill
& Scale

• Knowledge sharing, best practices
• Unified processes for efficiency
• Benefits from scale

Physician Alignment
& Accountable Health

Associate Empowerment

Growth

• Continued physician integration
• Continuum of care services
• Population health management
• Culture and talent
• Person-centered care
• Continuous improvement
• Ministry realignment
• System and market expansion
• New strategic plan

8

Community Benefit and Charity Care 2012
• Charity Care - $98.4 million at cost
•
•
•
•

$269,510 per day!
Increased by $18.7 million (23.5%) over 2011
Has increased every year in the past 7 years
Unified, system-wide financial aid policy

• Total Community Benefit (includes charity care) - $252.8
million
• 15.8% growth over 2011
• Charity care, unreimbursed Medicaid, community health programs,
subsidized health services, contributions to communities

• Over 197,500 lives touched by our community health
improvement services
• Health education programs, clinical services and
support services
• Of these, 107,160 lives touched by chronic disease programs
9

Ministry Excellence
Our health ministry is
earning national
recognition for
Quality, including:
− Denver hospitals among
“Top 15” health systems
nationwide
− SCL Health System (all
hospitals combined) in
the “Top 20%” of health
systems nationwide
− Six care sites received
Healthgrades Awards
for Clinical Quality: Top
5% in the nation

10

The Environment We Face

11

Health Care Costs are Unsustainable

97%
13

Consumers want low premiums; will accept narrow provider networks
to get them

other specialty drugs

18

Health Marketplaces/Exchange
Lessons learned from Massachusetts

19

Significant Market Share Upheaval in Massachusetts

)

20

Utilization Rates Continue to Decline

21

Why is “Revolutionary Behavior” an Imperative?

24

Rapid Change
•
•
•
•
•
•
•
•
•
•

Extreme pressure to reduce cost and lower prices
Private health exchanges
Public health exchanges/marketplaces
For-profit, niche providers
Mergers and acquisitions
Care shifts from inpatient to outpatient or “no-patient!”
Medicare reform
“Big Data” and eHealth
New, previously unthinkable partnerships
Shift to retail, person-centered, consumer focus

25

Paradigm Shift – an overused term from the 1990s?
• Paradigm Shift defined:
– Coined in 1962 by Thomas Kuhn, a scientist
– “A radical change in thinking from an accepted point of
view to a new belief.”
– “A paradigm is what members of a community, and they
alone, share.”

• Key question to be examined by us:
– Are we so “locked in” to our current paradigm of health
delivery that it will inhibit us from envisioning and building a
new future for our ministry?
– Or, can we open our minds to develop new beliefs?

• Radical change never happens quite as quickly as we
may initially think it will, but it does happen!
– When it sneaks up on us gradually, we may miss
opportunities if we are still viewing the world through the old
paradigm.
26

Quote from a wise planning executive

• “I tell people we’re not going to get
any more clarity. This is as good as it
gets.”

27

Familiar language
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•

AMI (Acute Myocardial Infarction)
HF (Heart Failure)
PN (Pneumonia)
SCIP (Surgical Care Improvement Project)
HAC (Hospital Acquired Conditions)
VTE (Venous Thromboembolism)
CLABSI (Central Line-Associated Blood Stream Infection)
CABG SSI (Coronary Artery Bypass Graft Surgical Site
Infection)
CAUTI (Catheter-Associated Urinary Tract Infection)
WOCN (Wound, ostomy and continence nursing)
POA (Present on Admission)
Admissions
Patient days
Outpatient procedures
Fee-for-service
Patient
29


Familiar Roles
•
•
•
•
•
•
•

Nurses
Technicians
Clerks
Housekeepers
Food service workers
Doctors
Administrators

30

New World

31

New Language
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•

MSSP (Medicare Shared Savings Program)
ACO (Accountable Care Organization)
BPCI (Bundled Payments for Care Improvement)
PCMH (Patient-Centered Medical Home)
ADSP (Adult Day Services Program)
AHN (Accountable Health Network)
PHOs/PPOs/MSOs
PMPM/PMPY (Per member per month/per member per year
Covered lives
“Big data” analytics
Risk pools
Population health
Virtual wellness platforms
Health Marketplace
Essential benefits
Gold, bronze, silver
HRO
Person-centered
Member

32

New Roles
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•

Care continuum coordinator
Medical home coordinator
Home health coordinator
ED life coach
Medication management specialist
Community resource specialist
Program/project manager
Payer analytics director
ACO operations
Lean sensei
Report writer specialist
Patient access managers
Customer service coordinators
Physician practice operation specialists
Knowledge management leaders
Business intelligence analysts
Digital content specialist
eHealth manager
Insurance/actuarial/underwriting specialist
Certified application counselor
33


How are We Transforming?

35

It Starts With a New Vision

36

It Requires Commitment to Coverage and Access to Care for All

37

It Requires a New Strategy

Person-Centered,
Consumer Centric Care

Ministry
Excellence

Accountable
Health

Physician
Partnership

Growth

Leverage Skill
and Scale

Associate Empowerment

38

It Requires a Shift From “Patients” to “Consumers”
• From “patients” (passive) to “consumers, members,
guests” (active) – “person-centered” as our new
mantra!
• More customer-centric “retail” strategies
• “Hardwire” approach to capturing customers/patients
– Scheduling, follow-up, digital connections

• Patients/customers as “members” of our system, not
episodic “transactions”
– How do we help them maintain/improve their health?

• “Digital channel” expectations
• Different leadership needed
• Competing for price sensitive customers with access to
lower cost niche providers
• Quality, safety and the care experience are Job One!
– “The price of admission”
39

It Requires a New Definition of “Values-Based Care”

Value
Our Values
•
•
•
•
•
•

Caring Spirit
Excellence
Good Humor
Integrity
Safety
Stewardship

• Person-centered
• Safe
• Health outcomes per dollar
spent
• Encompasses all services
that determine success for
patient’s needs
• Holistic (body, mind, spirit)
• Shared accountability
among providers
• Longer term

40

It Requires a Shift to Accountable Health Networks
We are moving community
care beyond just our medical
center campuses

To a distributed, connected network of the
care continuum we are developing in each
market

41

Denver Accountable Health Network
We are developing networks in each market*
Alliances and Partnerships:
• Lutheran Health Partners
• PHP/PPP
• New West Physicians
• Home Care Agencies
• Long Term Care Facilities
• Pre Hospital Agencies

• Kaiser Permanente
• CIGNA
- Associate Health Plan
• Anthem
- QHIP in 2011
• Other Payors

Inpatient
• OB 19%
• Dir Adm 29%

Outpatient

Denver Health
Network

• Hospital-based
• Freestanding

Information-driven
• Epic Inpatient and Outpatient
Bundled Payment
• ESJH ACE Project
• Medicare Bundled Payment
Clinical integration
• CPMG
• Lutheran Health Partners (LHP)
Pay for Performance/Quality Mgmt
Readmissions Management
• ELMC Transitions Program
• ESJH CMS Transitions Eligible
Chronic Care Management
• Chronic Care Model
• Cardiopulmonary
Evidence-Based Medicine

PreHospital

Aligned
Health
Systems

West Pines
IP & OP
Behavioral
Services

Colorado
Permanente
Medical Group

ED
Services

Aligned
Physicians

• 52% of IP Adms
• 42% of OP Visits

Kaiser

EPN & GME
Hospice
• Inpatient
• Outpatient
Home
Care

Colorado
Lutheran Home
• SNF w/Alzheimers
• Assisted Living
• Independent
Living

Long
Term Care

Contracted
• ED
• Hospitalists
• Imaging
• Etc.

Denotes aligned service

*Illustrative example

Employed

Private Practice
Physicians
42

It Requires Reorganization of Leadership
Community-Based
Health System

Medical
Center
Division
(Hospital)

Joint
Operating
Council

Medical
Group
Division
(Physicians)

“Co-Dependent Equals”

Integrated:
Composed of separate parts united together to
form a more complete or coordinated entity.

43

It Requires New Partnerships to Build the Care Continuum
Home Care Partnership with Univita Health: Coordination Through a Single Point of Contact
Traditional Home Health Industry Framework

Univita’s Model & Approach

Health Plan / Care Manager

Health Plan / Care Manager

Network
Development

Discharge
Planner

Physician
Coordinator

Home Health
Agency

DME /
Respiratory

IV Provider

Patient

Physician

Discharge
Planner

Physician
Coordinator

Univita

Patient

Focus on Unit Cost


Network
Development

Physician

Focus on Outcomes

Property of Univita Health, 2012

44

It Requires Partnerships for Population Health Management
Population management infrastructure development
• Contracted services of Lumeris, Inc.
– Cloud-based data warehousing and electronic medical record
– Market assessment, strategy and tactical planning support
– Full risk population management decision support and
reporting tools
– Accountable Care Training Institute
– Actuarial and TPA capability
– Associate health plan data management support
– Patient registries, clinical quality and preventive services
reporting

45


45

It Requires Management of Three Distinct Patient Populations

HighRisk
Patients

Rising-Risk
Patients

Low-Risk
Patients

5% of patients;
Usually with complex
diseases, comorbidities

15-35% of patients;
May have conditions
not under control

60-80% of patients;
Any minor conditions
are easily managed
Source: Advisory Board


Dedicated team-based
care
Trade high-cost services
for low-cost management

Avoid unnecessary
higher-acuity,
high cost spending

Keep patient healthy,
loyal to the system
(“sticky”)
46

It Requires Demonstrated Leadership in Managing the Health of
our Own Associates (Employees)
•

•
•

•

•

•

•

Our total annual spend for health coverage for our associates, spouses and dependents
amounts to $78.6 million per year, and the associate cost contribution to premiums is about
$22 million per year (this does not include deductibles, coinsurance and copayments, which
are an additional cost to our associates and families)
19% of our spend is in prescription drugs
There were 129 “catastrophic” claims (serious conditions like cancer and major orthopedic
care that exceed $100,000 per claim) in 2012, and the median spend per claim was 23%
higher than the Cigna norm for their entire covered groups
Our “outlier” (very long) lengths-of-stay for inpatient care were in four areas: major
gastrointestinal disorders, cardiothoracic surgery, joint replacements and elective back
surgery and mental health/substance abuse care
Young adults (ages 18-26 yrs.) accounted for 11% of adult inpatient admissions, and 33% of
those admissions were for mental health/substance abuse care (an unfortunate sign of the
times?)
Expenditures on emergency care were our second highest outpatient costs. Our emergency
department usage is higher than external benchmarks. And young adults had
disproportionately higher rates of ED utilization than the rest of our population
Chronic pain care drives significant outpatient costs for our population, with interventional
pain procedures, advanced imaging and prescription drugs

47

Opportunities to Improve Health of Our Associates
• Care management opportunities for those experiencing
chronic pain
• Better coordination of care for those with requiring joint
replacements
• Use of more non-surgical treatment options for those
with low back pain who would otherwise end up having
elective back surgery where the medical evidence on
outcomes may not lead to better health status
• Improving access to primary care and urgent care for
common ambulatory conditions to avoid use of
expensive emergency services
• More options to encourage routine preventive care and
screening, and use of outpatient mental health and
substance abuse support for young adults
48


48

It Requires a Commitment to PERFECT CARE

• We are not striving for incremental improvement
• We are striving for PERFECTION in the care experience:
– Quality, safety, satisfaction
– Empowered and engaged patients and families
– Outcomes

• To be a “trusted partner” means we must be a HIGH RELIABILITY
ORGANIZATION
• Our Model for Perfect Care: Quality, Safety and Care Experience
Collaboratives
– Focused teams learning, identifying and implementing best practice
solutions

• This is meaningful work that requires teamwork to move us to the
next level!
49

It Requires a Commitment to Lower Cost
Transformation” Project

Accountable Health
Transformation (AHT) is our
operations improvement
framework.

Achieve Medicare profitability
within 3 years.
So far: $100 million.
To go: $150 million.
Year 1
Develop
Plan

Year 2
Implement
Plan

Communicate
& Engage

Operational Levers

Year 3

Levers (Examples)

Operational
- Labor Productivity, Revenue Cycle,
Supply Chain, Administrative
(System Services)
Utilization
- Utilization Management and
Reduction in Unnecessary
Variation in Care
Portfolio
- Outpatient Growth, Surgical
Services Growth, Program and
Service Line Contribution Margin
Analysis/Rationalization

Utilization Levers
Portfolio Levers
Clinical / Quality Levers

Clinical / Quality
- Readmission Rates, Core
Measures, and Care Experience
Performance
50


It Requires Leveraging Skill and Scale of Being a System
Leveraging our Skill,
Knowledge and Relationships

•
•
•
•

Results from size (sites, revenue)
More tangible
Quantifiable in financial terms
Requires more commitment to
realize benefits

• Results from size and scope (people, situations)
• Generally quantifiable in terms of increased
learning and savings from “recreating the wheel”
• Design and implement work products together
• Rapid replication and adoption of best practices

51

It Requires “Connecting the Silos”

52

Servant Leader - Partnership Behaviors
Accountability for results

Engagement and enthusiasm for change

Adaptability and continuous learning

Trust, respect and collaboration

Transparency and candor

Efficient, data-driven decision making

Urgency and follow-through

53

It Requires Carving a New Growth Path
Grow Market Share
of Volume

Grow Market Share
of Lives

• Best-in-Class
Acute Care
Destination

• Full-Service
Population Health
Manager

• ConsumerOriented
Ambulatory
Network

• FinanciallyIntegrated
Delivery System
(Insurer)


Source: Advisory Board

54

It Requires Growth That is Essential to Invest in Our Future
• Not growth for growth’s sake
• $4-5 billion size is a goal to leverage skill and scale
• IT investments, care management and clinical integration investments,
best-in-class system services such as revenue cycle and supply chain

• Can occur through shared services, partnerships,
management agreements, JOAs, mergers
– Alliances and partnerships, not control

• Growth opportunities pursued:
•
•
•
•
•

Local, stand-alone providers/hospitals
Physician groups
Home care
Joint ventures
Other Catholic, secular and faith-based systems

55

It Requires Focus and Execution

“Great execution,
less initiatives”

56

Closing Thoughts

57

What We Covered
•
•
•
•
•

Brief background on SCL Health System
The environment we face
Why is “revolutionary behavior” an imperative?
How are we transforming?
Closing thoughts

58

Incumbents vs. Revolutionaries
• Incumbents
– The old model has worked for an extended time period
– In “Maintenance Mode” – don’t want to mess with “the
formula”
– Leverage brand and historical reputation
– Adopting any new approach puts the model at risk
• Can cannibalize one’s own business

– Very few have adopted a revolutionary mindset and have
been successful at changing the model

• Revolutionaries
– Victory comes by changing the model
– Being scrappy, open to invention, leverage out-of-the-box
thinking

59

Revolutionary Requirements
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•

New vision
Commitment to coverage and access
New strategy
Shift from “patients” to “consumers”
New definition of “value”
Shift to accountable health
Reorganization of leadership
New partnerships
Managing three distinct patient populations
Demonstrated leadership in managing the health of our own
associates
A commitment to perfect care
Lower cost
Leverage skill and scale
Connecting silos
Carving a new growth path
Focus and execution
60


Revolution, or Evolution?

Axiom:

“Really fast evolution requires
a revolution!”
- Mike Slubowski

61

Ministry and Business Perspectives
(Our Success Model)
•
•
•
•
•
•
•

Accountable Care
Community Benefit Ministry
Community Health
Person-Centered Care Experience
Quality and Safety
Access to Care
Drives
Population Health

Ministry

The Ministry is why we exist!

Business
Model
To Support

• Commitment to Excellence
(Top Decile/Zero Defects)
• Access to Capital and Credit Strength
• Geographic Diversity
• Credit Strength
62

Pulse - Revolutionary Mindset

Empfohlen

Empfohlen

Weitere ähnliche Inhalte

Was ist angesagt?

Was ist angesagt? (20)

Andere mochten auch

Andere mochten auch (9)

Ähnlich wie Pulse - Revolutionary Mindset

Ähnlich wie Pulse - Revolutionary Mindset (20)

Mehr von WRONG PERSON

Mehr von WRONG PERSON (20)

Kürzlich hochgeladen

Kürzlich hochgeladen (20)

Pulse - Revolutionary Mindset